Article
Syringomyelia associated with arachnoiditis ossificans: Report of 4 cases
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Authors
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Hamid Borghei-Razavi
- Department of Neurosurgery, Clemens Hospital, Münster
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Khairi M. Daabak
- Department of Neurosurgery, Clemens Hospital, Münster
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Uta Schick
- Department of Neurosurgery, Clemens Hospital, Münster
| Published: | May 21, 2013 |
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Outline
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Objective: Our objective was to summarize the clinical and histological features of arachnoiditis ossificans (AO). We review the different clinical and radiological classifications, clinical presentation, treatment modalities and present 4 cases of AO with concomitant syringomyelia, discussing the development of this accompanying AO-phenomenon. We furthermore discuss the histopathogical differences between calcified spinal meningioma and AO.
Method: We analyzed four cases of AO, their clinical presentation, the radiological diagnostic, surgical technique, the postoperative course and postoperative radiological imaging. We review the literature, underline the pathological, clinical and radiological classifications, and the typical clinical presentation. We also review the literature regarding the treatment of concomitant syringomyelia, and its pathophysiological development
Results: Paraparesis was the leading presenting symptom, with an average of 8 years to 4 months before symptom presentation and surgery. In two cases there was a history of trauma and in another case a previous myelography in the clinical history. In the fourth case there was no history of previous trauma, myelography, or surgical procedure, which we nominate as spontaneous. The preoperative diagnostic consisted of MRT and CT. The operative technique consisted of spinal canal decompression and median myelotomy with or without laminoplasty. All four cases improved clinically and radiologically. Reviewing the literature we found only 9 other previous documented cases of AO presenting with syringomyelia. Eight patients with AO with Syrinx formation underwent surgery, and seven of them, including our cases, improved clinically.
Conclusions: The etiology of AO is surgery, trauma, infection, myelography, SAH, or meningeal irritation and other causes. Sometimes it presents itself as an spontaneous phenomenon. Laminoplasty or laminotomy or decompression with or without syrinx drainage and shunting remain the standard of care.
